{
  "abstract": "In 2023, Palliative Care Victoria launched the Dignified and Respectful Decisions project, developing resources for substitute decision makers of older adults in Residential Aged Care (RAC). During the foundation work of the project, the team consulted a diverse range of health professionals and people in the community with lived experience. From these conversations, three key insights on the complexity of Advance Care Planning (ACP) for substitute decision makers, were established:Carer burden in the transition to RAC:There is significant distress experienced by informal carers when a person moves into care which can significantly influence any decisions they are asked to make.Moral distress in identifying preferences:When individuals can no longer communicate their wishes and have not previously shared them, substitute decision makers are frequently left trying to identify what they would prefer without any clear guidance.The importance of early and often conversations:Health professionals and the community often avoid discussions about future health care needs and end-of-life preferences, leaving substitute decision makers unprepared when a person’s condition worsens.This presentation aims to inspire change in how health professionals work with substitute decision makers in RAC. This includes:Adopting a structured approach for ACP in RAC: ACP in this context is complex and heavily depends on substitute decision makers. A more structured approach that considers the family’s needs should be implemented when having these discussions.Offering greater support to substitute decision makers:When a person cannot complete their ACP, substitute decision makers should receive greater support to help identify the individual’s preferences, including the use of appropriate tools for documentation.Intentionally targeting awareness for decision makers: When a substitute decision maker is actively supporting someone, they are more vulnerable to social isolation, carer fatigue and can seem harder to engage with. Increasing awareness about ACP for these individuals is better achieved using a saturation approach which involves imbedding consistent messaging and resources in both health services and throughout their community. This provides them the opportunity to engage with the information at a time when they are ready and available.This submission emphasizes the complexity faced by substitute decision makers in RAC, particularly when previous ACP discussions have not occurred. By addressing these challenges, health professionals and policymakers can find innovative ways to engage substitute decision makers more effectively, reducing the burden on decision makers themselves and improving care outcomes.",
  "authors": [
    {
      "affiliations": [
        "Palliative Care Victoria, East Melbourne, Australia"
      ],
      "name": "Tiffany Button"
    }
  ],
  "title": "35 Supporting substitute decision makers of older Australians: learnings from the forgotten voices behind care",
  "uid": "08fb6161-87d7-588e-972c-fae12aacb723"
}